The purpose of this blog is to gather information about how to support caregivers of children. The quality of the caregiving relationship in infants and young children, central to the healthy development of the growing child, can be enhanced by attention to the caregivers in the form of education and other support. This blog will become an archive for information on these issues.

Tag Archives: Lynne Murray

How do mothers affect the development of emotional regulation in infants? Murray showed a film of a study with mothers and 14-month infants in which the mother is first asked not to interact with the child when the researcher puts a toy frustratingly out of reach. The child naturally becomes distressed and remains so. When the mother is allowed to support her child, she responds quickly with an empathic facial expression. Then she says, “Oooh, how do you feel? Perhaps we can do something!” while giving a hopeful and suggestive facial expression. The mother begins to occupy the child by playing a little game with her fingers so that it distracts the child from her frustration at not being able to get the toy. It is clear how this kind of interaction repeated over and over can support the child’s growing tolerance for frustrating experiences.

In another wonderful film, a (non-depressed) mother is giving a bath to a 15-month girl. The mother is washing her face, and the child is tolerating this relatively well, but when she tries to brush her teeth, the child objects forcefully. This child turns out to have a firey temperament with a low threshold for frustration, and the mother must take account of the temperamental characteristics of her baby. The mother pauses a bit. She has a little toy that squirts water and uses it to squirt water on the toy the baby is playing with, making a connection with her. The baby responds happily, and then the mother builds on this connection and focuses on what the baby is doing. Mother pretends to brush her own teeth. The baby smiles and lets the mother brush her teeth, then takes the tooth brush and tries to do it herself. Of course, depressed mothers have little tolerance for this step-by-step reciprocal play at bath time. They are more likely to either forcefully take the toothbrush and get the job done over the objections of the baby, or withdraw.

What are the mechanisms by which the early mother-child relationship affects the development of depression in the child? First there is emotional contagion (Field, 1984, 1988). There are also effects on the HPA axis (Murray et al, 2010 a). Finally, there is the link between insecure attachment and low resilience (Sroufe et al, 2005). One of my favorite studies, given my interest in vocal tones and non-symbolic communication, is one in which mothers were coded according to their speech tones (Murray, 2010). Falling intonation, non-rhythmicity, and monotony were significantly more prominent in PND mothers. In the non-depressed mothers, there was a rhythmic quality, with variability in pitch. What is the human equivalent of Michael Meaney’s “low licking mothers” whose babies had elevated cortisol levels? It is the low engagement of depressed human mothers. Halligan et al,, in 2004 and 2007) found that the 13-yo children of depressed mothers had elevated morning cortisol levels, which was predictive of depressed state. In one film of a 7-year old child of a PND mother playing a game with a peer, the child was initially triumphant when she was winning, but when she lost the advantage, she also lost her composure. Even when you control for marital conflict, maternal depression at the beginning of the infant’s life proves to be a predictor of depression at 16 years (Murray et al, 2011).

In conclusion, PND is associated with a range of disturbances in the mother-infant relationship. Babies’ outcome is affected in diverse domains- cognition, behavior, and affect, to name several important ones. Each outcome might have a specific developmental trajectory, such that for example, a depressed child may have no cognitive impairment. One of the most important take away points from this presentation is that obstetricians and pediatricians must get better and better at identifying and treating mothers with PND. Another point, though with less immediate importance, is for mental health clinicians learn to elicit the history of a PND in their evaluations of children with psychiatric problems. Finally, it is crucial to remember that nothing is written in stone. These problematic patterns may be interrupted at any point in the process – whether by the early intervention I have just been advocating, psychotherapy in the older child or adolescent, or by positive life events – a new supportive partner for the mother, the healing of an important relationship from the past, a better work situation, a new group of supportive friends for the child, the discovery of a talent in the child that brings positive self esteem to the whole family – that change the family trajectory in a better direction. Pointing out risk factors is never helpful without an equal emphasis on the resiliency factors that create a natural correction on a family life turning off course.

The last weekend in the IPMH fellowship, we were treated to researchers on postnatal depression (PND) from the U.K., Lynne Murray and Peter Cooper. In this summary, I cannot do justice to the rich presentation and discussions that followed. What I will do instead is to note some of the main points and then illustrate them with descriptions of some of the wonderful film examples Lynne and Peter showed us. At the end I will include references to some of the studies so that those who are interested may read about the research in greater detail. http://www.reading.ac.uk/pcls/people/lynne-murray.aspx

On Friday, Lynne Murray lectured on the effects of PND on the child. She pointed out that PND occurs at a time when the infant is maximally dependent on the mother and also highly sensitive to the caregiver’s communications. Depression influences the communications that the caregiver gives the baby. The baby picks up for example whether the caregiver’s eyes are open or closed, whether her gaze is direct or indirect. By 8 weeks old, the baby is ready for “proto-conversations” – a variety of gestures and expressions that indicate the baby’s affect and intention and that demand contingent responses to maintain engagement.

When a mother is clinically depressed, she may fall into two broad patterns of insensitivity, either remoteness and disengagement, or hostility and intrusiveness, and in turn the infants may avoid contact and become depressed themselves. Boys are more vulnerable, perhaps because they intrinsically tend to need more support.

Murray showed a film of the first pattern of interaction with a depressed mother and her 12-week old baby. The mother says to her baby, “Oh, poor baby! I feel so sorry for you sitting there (in an infant seat) all by yourself! You’re struggling to get out!” In this example, the mother seems to perceive her baby as feeling as trapped as she herself might feel. Perhaps because she is weighted down by her own negative affect state, the mother cannot respond to the baby’s cues of widening eyes and open mouth, and so the baby gives up and withdraws. Naturally, the mother gets discouraged. A cycle gets going in which mother and baby both feel helpless.

In a film exemplifying the second pattern, the mother seems a little speeded up and anxious. She behaves in an pushy manner and cannot seem to sit back and attend to the baby’s cues. As the baby pulls away, the mother pushes forward. The mother changes the play agenda all the time; she decides the baby is fed up with a toy without any evidence from the baby’s behavior, and she takes it away, abruptly substituting another. This interaction also ends up in a discouraging experience for both mother and baby.

Two experimental paradigms demonstrate the effect on the baby of an interruption of maternal responsiveness. The first is Ed Tronick’s still face procedure in which the mother is instructed to interrupt her play with her baby and become unresponsive for a period of 1-2 minutes; the babies in these experiments are powerfully affected by the loss of their mother’s responsiveness. The second is a study by Lynne Murray that illuminated the refinement of the contingency response pattern between young infants and their mothers (Murray & Trevarthen, 1985). When babies were shown their mothers’ images on a television screen as the mothers were reacting to them in real time, the babies responded to them as if they were their interactive partners. Then when the mothers’ images were played back to them with the timing manipulated so that there was no contingency with the babies’ gestures (same mother, same baby, but gestures played back a little later than they were made), the babies’ gaze dropped off, the smiling stopped, and the baby became confused and distressed.

What are the ways that non-depressed mothers behave that support their babies’ psychological growth and development? The mother of a 3-month old facilitates the baby’s attention by closely monitoring the baby’s expressions to maintain the baby’s attention on an object, varying the experience enough to keep the baby’s interest. This is difficult for a depressed mother to do because she has difficulty picking up the baby’s cues. The non-depressed mother will also facilitate the baby’s potential by holding the toy at the right distance and keep the baby in the right position so that the baby can get the maximum benefit out of the toy. The non-depressed mother of a 12-month old will for example pick up toys to make them available to the child – indicating what the baby can do with it without taking over, steadying the toy so that the baby can achieve his own goals. In an example of a non-depressed mother sharing a book with her baby, the mother put her thumb under the page so that the baby could more easily turn the page himself.

Both the general patterns displayed by PND mothers – without intervention – can end up in persisting interaction difficulties, and in different kinds of negative outcomes in the developing child. Examples of these outcomes are a depression in IQ and school achievement, behavior regulation problems in childhood, and depressive disorders in childhood (Murray et al, 2010).

On vacation, I have a chance to relax in the beautiful countryside and reflect. I have been reading more about the child-caregiver relationship and consideringdifferent “takes” on what makes it work and not work so well.

One of the interesting researchers I have been reading is Colwyn Trevarthen. He writes that the newborn expresses his intentions to connect with his caregiver in rhythmic movements. The body movements of the infant communicate the intention to “tell a story” with the caregiver, and have a quality of “musicality” in their rhythmicity. I remember seeing Trevarthen present a film of a father holding his impossibly small premature baby, while he sang to him. The baby’s tiny foot made up and down movements rhythmically, in time with his father’s singing.

Trevarthen says that babies are born with the capacity and the intention to make meaningful connections with their caregivers and that these connections are made through purposeful, musical body movements, generated by the lower part of their brains, not their thinking brains. Babies are very sensitive to the contingency of the responses of the caregiver to their own movements and also sensitive to ways of complementing the movements of their caregivers.

One of the observations Trevarthen made that stimulated my thinking was that most of the time the babies were the leaders in the exchange with their caregivers, and the mothers were following. Much of the periodicity in the exchange between caregiver and infant originates from the infant. Infants anticipate cooperative and positive responses to the behaviors that they direct towards their caregivers, and they are very sensitive to surprises. Experiments in which the mother’s responses were deliberately made non-contingent, such as an experiment by Murray in which she played the image of the mother on film to her 2-month old baby just a minute later, so that what the mother was doing in response to the baby was just a little off, demonstrated how sensitive the infants were to the contradiction to their expectations of how their mothers would behave towards them. The babies reacted with distress and withdrawal. Of course, mothers are equally sensitive, on a non-conscious level, to non-contingent responses her baby makes to her.

That got me to wonder about the experience of the mother of an infant who is unable to join with her to create that “communicative musicality”, especially if the mother’s reactions are out of her awareness and so she cannot make sense of them. She is likely to perceive herself as doing something wrong and not understand what that is, not understand what she should be doing differently. There are many infants who may have difficulty in creating expressive movements and coordinating them with their mothers. In ASD, we know that there are different neurobiological problems that interfere with the development of the social brain. The neural circuits mediating language and behavioral flexibility do not function normally in ASD children.

Since an early theory of language development by behavioral psychologist Karl Lashley (1951), now supported by some current studies, postulates that language emerges from serial ordering of movements, and since developmental researchers have also described the synchronous coordination of purposeful rhythms as the basis for the development of communication, it seems likely that at least some children who are later diagnosed with ASD – and also some other children with neurodevelopmental disorders – would initially have disturbed expressive movements in infancy. This could be expected to have an important impact on the mother. The more we learn about early development, the more we will be able to support caregivers in making a connection with their challenging babies.

About

Alexandra Murray Harrison, M.D. is a Training and Supervising Analyst at the Boston Psychoanalytic Society and Institute in Adult and Child and Adolescent Psychoanalysis, an Assistant Clinical Professor of Psychiatry, Harvard Medical School at the Cambridge Health Alliance, and on the Faculty of the Infant-Parent Mental Health Post Graduate Certificate Program at University of Massachusetts Boston. Dr. Harrison has a private practice in both adult and child psychoanalysis and psychiatry. In the context of visits to orphanages in Central America and India, Dr. Harrison has developed a model for mental health professionals in developed countries to volunteer their consultation services to caregivers of children in care in developing countries in the context of a long term relationship with episodic visits and regular skype and video contact.